POS0587 TRAJECTORIES AND FACTORS INFLUENCING THE EVOLUTION OF HAND GRIP AMONG PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: B. Squercioni, B. Pereira, M. Beauger, M. Couderc, F. Ladouce, S. Malochet, S. Mathieu, P. Marie-Eva, M. Soubrier, A. Tournadre
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is characterized by an early reduced grip strength which persists over time despite the remission of the disease suggesting the presence of a sarcopenia. Objectives To study the evolution of the grip strength measured by the handgrip. by identifying different trajectories and associated factors. Methods Patients with active RA who visited the Rheumatology Department of Clermont-Ferrand University Hospital for initiating bDMARD were invited to participate to the longitudinal cohort RCVRIC analyzing cardiovascular risk and chronic inflammatory rheumatic disease. Within the RCVRIC cohort 175 RA initially underwent a handgrip determination. 143 patients had at least 2 handgrip measurements over 2 years, allowing analysis of trajectories by the “Group Based Trajectory Modeling” method. For the trajectories, handgrip was expressed in terms of percentage of the theoretical value defined according to age and sex. The clinical characteristics of the disease, the therapeutic response, and the body composition associated with each trajectory were analyzed. Results At inclusion, the handgrip was normal among only 4% of patients, with an alteration of 51% of its theoretical value. After 2 years of follow-up, a majority of patients improved their handgrip trajectory to reach an average of 68% of the theoretical one, but only 15.7% of the patients normalized their handgrip. Four trajectories have been identified along with associated factors: 1st trajectory consists of low handgrip with little improvement and was composed of: 9 patients (6.3%), median age 60 years [53.6;69.3], 88% women, disease duration 17.99 years [6.78;24.9], DAS 28 ESR 4.68 ± 1.29, and initial handgrip 21% of the theoretical value [8;24]. 2nd trajectory shows good improvement (+72%) and was composed of: 70 patients (49%), median age 58.9 years [54.4;64.3], 84% women, disease duration 5.99 years [1.46;14.8], DAS 28 ESR 4.43 ± 1.07, and initial handgrip 32% of the theoretical value [17.8;46.4]. 3rd trajectory shows moderate improvement (+25%) and was composed of: 43 patients (30%), median aged 60.7 years [45.7;69.4], 79% women, disease duration 3.5 years [1.25;9.9], DAS 28 ESR 4.0 ± 1.03 and initial handgrip 60% of the theoretical value [48.2;76]. 4th trajectory shows high handgrip and was composed of: 21 patients (14.7%), 57% women, median age 57.9 years old [49.7; 67.4], disease duration 3.81 years [2.14; 10.7], DAS 28 ESR 3.68 ±1.29 and initial hand grip 92% of the theoretical value [85; 100]. Significant differences at inclusion between the 4 trajectories were observed . The 4th trajectory was characterized by a higher proportion of men (p=0.05), lower disease activity (DAS 28 ESR (p=0.02), SDAI (p=0.04)), better initial handgrip (p=0.03) and 6 min walk test (p=0.0001), and a lower percentage of fat mass (p=0.04). In contrast, a higher disability (HAQ, p=0.002), a lower total lean body mass (p=0.001) and poorer therapeutic response (p=0.04) were noted in trajectories 1 and 2. Conclusion After 2 years of follow-up, a majority of patients improved their handgrip trajectory. However, very few patients normalized their hand grip. Four trajectories of handgrip were identified; the main indicators of hand grip’s improvement were the control of the disease activity, low functional disability, walking performance, a low percentage of fat mass and high lean mass. References [1]Cruz-Jentoft AJ, and al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. janv 2019 [2]An HJ, and al. Sarcopenia in Autoimmune and Rheumatic Diseases: A Comprehensive Review. Int J Mol Sci. 7 août 2020 [3]Shiratori AP and al. Evaluation protocols of hand grip strength in individuals with rheumatoid arthritis: systematic review. Rev Bras Reumatol. avr 2014 [4]Dodds RM, et al. Grip strength across the life course: normative data from twelve British studies. PloS One. 2014; Acknowledgements I thank the department of rheumatology of Clermont Ferrand. Disclosure of Interests None declared.